How Do You Prove You’re Competent? (And Why Pharmacists Get Struck Off)
Here’s an uncomfortable truth the profession doesn’t say often enough: a certificate does not make you competent. In 2025 a pharmacist was suspended for prescribing irrationally and unsafely — outside their competence. They almost certainly held qualifications. It didn’t save them, because the regulator doesn’t ask what your certificate says. It asks what you actually did.
The video behind this piece — watch it on TikTok.
The short version
- Competence is evidenced, not conferred. A course starts you; it doesn’t finish you.
- The definition that matters: the habitual and judicious use of knowledge and skill in daily practice (Epstein & Hundert).
- Work within your scope of practice. Stepping outside it is the fast route to a fitness-to-practise case.
- A pharmacist was suspended in 2025 for prescribing outside their competence — qualifications didn’t protect them.
- Prove it in three steps: course → portfolio of evidence → credential.
What competence actually means
Ask most people what makes someone competent and they’ll point to a qualification. But the definition clinicians are actually held to is more demanding. The most cited one comes from Epstein and Hundert: competence is the “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individual and community being served.”
Read those two words again: habitual and judicious. Habitual means you do it reliably, again and again — not once, in an exam, under ideal conditions. Judicious means you exercise good judgement about when and how. Neither of those can be printed on a certificate. They live in your daily practice, or they don’t exist at all.
A course can give you knowledge. Only your applied, supervised, reflected-on practice can prove competence — and that’s exactly what a regulator examines.
Two frameworks that make this concrete
If Epstein & Hundert gives you the definition, two well-known models show you the shape of the journey.
Miller’s pyramid: from “knows” to “does”
Miller’s pyramid describes four levels of clinical ability: knows → knows how → shows how → does. A course and an exam get you to the bottom two — you know the facts and you know how you’d apply them. But competence lives at the top: “does” — what you actually do with a real patient, on a real day, unobserved. Most certificates only ever test the bottom half of the pyramid. Regulators judge you on the top.
Benner: novice to expert
Patricia Benner’s model tracks the path from novice to advanced beginner, competent, proficient and finally expert. The crucial insight: you don’t leap straight to competent by passing a test. You move up through experience — accumulated, reflected-on, real-world practice. Competence is a stage you grow into, not a badge you’re handed.
| Model | What it tells you | Where a certificate sits |
|---|---|---|
| Epstein & Hundert | Competence = habitual, judicious use in daily practice. | Doesn’t capture “habitual” at all. |
| Miller’s pyramid | Knows → knows how → shows how → does. | Tests the bottom; regulators judge “does”. |
| Benner | Novice → expert, driven by experience. | A course is the start of the climb. |
Scope of practice: the line you must not cross
All of this comes together in one practical idea: your scope of practice. That’s the range of clinical activity you’re trained, competent and currently up to date to do safely. It’s personal — two prescribers with identical qualifications can have completely different scopes, because scope is about evidenced competence, not certificates on the wall.
Working within your scope means only prescribing or treating where you can show competence. Stepping outside it — prescribing in an area you’re not competent in — is one of the fastest ways to end up in front of the regulator. Which brings us to the case that prompted this piece.
Why pharmacists actually get struck off
In 2025, a pharmacist was suspended for prescribing irrationally and unsafely — practising outside their competence. Cases like this rarely turn on whether the person held a qualification. They turn on the decisions: were they safe, rational, evidence-based and within the person’s competence and scope? When the answer is no, a certificate is no defence.
This is the part I want every pharmacist and prescriber to internalise. The GPhC doesn’t regulate your certificate — it regulates your practice. Fitness to practise is judged on what you do, how you reason, and whether you stayed inside the boundaries of what you could actually evidence. If you can’t evidence competence in the thing you did, the qualification behind it won’t protect you. (I’ve written more on how that process works in the GPhC fitness-to-practise process.)
Which is why proving competence — on paper, in a portfolio, through credentialing — matters as much as acquiring it.
How to actually prove you’re competent
So how do you protect yourself and, more importantly, genuinely practise well? You build evidence over time instead of leaning on a single certificate. Think of it as three steps — the same three on the diagram above:
- Course — get the knowledge. A good course (Level 7 learning for prescribing-level work) gives you the foundation. It’s necessary. It just isn’t sufficient.
- Portfolio — evidence the practice. This is where competence is actually shown: a defined scope of practice, self-assessment against the RPS prescribing competency framework, real anonymised cases, reflective notes, audits, feedback, and supervision or assessment by a competent practitioner. This is your “does” on Miller’s pyramid, written down.
- Credential — get the external marker. Where it exists, formal RPS credentialing gives you an independent, recognised sign-off — proof that isn’t just your own say-so. It’s the difference between claiming competence and having it verified.
Do those three and you’re not gaming a regulator — you’re genuinely safer, and you can demonstrate it if anyone ever asks. For a deeper walk-through, see my guide on how to demonstrate clinical competence.
How I can help
Helping pharmacists build genuine competence — and the portfolio and credentialing to evidence it — is exactly what I do through MEDLRN. That means Level 7 learning, portfolio support, scope-of-practice work and the structure to prescribe safely and prove it. If you want to build competence you can actually stand behind, let’s talk.
Frequently asked questions
What does clinical competence actually mean?
The most cited definition comes from Epstein and Hundert: competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the person and community being served. The key words are habitual and judicious — it’s what you reliably do, well, day after day, not something you did once on a course. That’s why it can’t simply be handed over by a certificate.
Does a course make you competent?
No. A course gives you knowledge and starts you up the ladder, but competence is evidenced, not conferred. A certificate proves you attended and passed at a point in time; it doesn’t prove you habitually apply that learning safely in daily practice. Regulators and courts look at what you actually do. Real competence is shown through applied practice, supervision, a portfolio of evidence and, where available, formal credentialing.
What is scope of practice?
Your scope of practice is the range of clinical activities you’re trained, competent and up to date to perform safely. It’s personal — two prescribers with the same qualification can have very different scopes. Working within your scope means only prescribing or treating where you can evidence competence. Stepping outside it is one of the fastest ways to face a fitness-to-practise investigation.
Why do pharmacists get struck off or suspended?
One recurring reason is practising outside their competence — for example prescribing irrationally or unsafely in an area they weren’t competent to work in. In 2025 a pharmacist was suspended for exactly this. The regulator doesn’t ask whether you held a certificate; it asks whether your decisions were safe, rational and within your competence and scope. If you can’t evidence that, a qualification won’t protect you.
How do I prove I am competent?
Build evidence over time rather than relying on one certificate. Work within a defined scope of practice; assess yourself against a recognised framework such as the RPS prescribing competency framework; keep a portfolio of real cases, reflections, audits and feedback; seek supervision and assessment from a competent practitioner; and, where it exists, pursue formal credentialing (e.g. RPS credentialing) as an independent marker. Course for knowledge, portfolio for evidence, credential for the external sign-off.
Comments
Do you think the profession leans too hard on certificates over evidenced competence? I’d like your view — leave a comment below; I read them all.